Manuals, Forms, & Support
NOTICE: In-State vs. Out-of-State Providers
Because Ped-I-Care is required to follow Medicaid guidelines, in-state providers are to be used prior to seeking out of state (OOS) providers.
Please access our T19 and T21 provider directories to locate an in-state, contracted provider before submitting requests for an OOS provider.
Claims Information: MMA/Title 19
Claims Information: CHIP/Title 21
Emdeon Electronic Payer ID: EM843
Availity Electronic Payer ID: M3FL0012Send paper claims to:
CMS Plan Title 19
PO Box 981648
El Paso, TX 79998-1648
Click here to check
Emdeon Electronic Payer ID: EM205
Availity Electronic Payer ID: M3FL0014Send paper claims to:
MED3OOO/Ped-I-Care Title 21
PO Box 981733
El Paso, TX 79998-1733
Click here to check
- Title 19 (Medicaid) Pharmacy Benefits Manager: Magellan
- Phone: (800) 603-1714; Fax (800) 424-5714
- Prior authorization forms: http://ahca.myflorida.com/Medicaid/Prescribed_Drug/pharm_thera/CMSNpaforms.shtml
- Title 21 (CHIP) Pharmacy Benefits Manager: MedImpact
- Phone: (800) 788-2949
- CMS website pharmacy information: http://www.floridahealth.gov/programs-and-services/prevention/pharmacies/index.html
- MedImpact website: https://www.medimpact.com/
Forms & Applications
- Credentialing – CMS Approval Application
- CMS Provider Instructions
- Provider Update Form – January 2017
- Authorization Requirements – July 27 2016
- Ped-I-Care Authorization Request Form -Nov 7 2017
- Special Exemptions Form – July 2016
- Please use when requesting any non-covered benefit item, genetic test, or PKU food request.
- Genetic Test Request – July 2016
- Low Protein Foods Request (PKU)
- Claims Appeal Form – July 15 2016
- Authorization Denial Appeal Request Form – July 2016
Note: Providers must obtain written consent from member, parent or guardian to appeal on the member’s behalf. Please submit with appeal.
- Therapy Services Authorization Checklist – July 2016
- Concordia Behavioral Health – Provider Support
- Ped-I-Care School Verification Form – July 2016
- Ped-I-Care Work Verification Form – July 2016
- Prenatal Risk Screening Form (DH Form 3134)**
- Postnatal Risk Screening Form (DH Form 3135)***
- TB & Lead Risk Assessment – July 22 2016
- Out-of-State Authorization Request Form – October 21 2016
- CMS Clinical Eligibility Attestation
Resources & Training
- Provider Manual – T19 – February 7 2017
- Provider Directory – Title 21 (CHIP) – Updated
- Provider Directory – Title 19 (MMA/Medicaid)
- Concordia Behavioral Health Directory
- Ped-I-Care Quality Improvement Resources for Providers – 2017-02-07
- AHCA Consumer Call Center Information
- Prevention of Fraud & Abuse Training
- How to Report Medicaid Fraud Waste or Abuse
- The Deficit Reduction Act of 2005 and UF COM Policy
- Cultural & Linguistic Competence Plan – 2017
- County Resources Guide – January 2017
- Communication Resources Tool: A System That Works – 2017
- Florida DCF Training – Mandatory Reporting of Child Abuse and Neglect
- Florida DCF Training – Reporting Abuse of Children and Vulnerable Adults
- MMA Overview Training
- Clinical Pathways and Guidelines: ePresentations and Continuing Education
- Florida Child Psychiatry Consult Helpline
- Florida Bureau of Immunization
* PCPs refer to in-network specialty providers for services needed by the child; specialists may also make referrals to other specialists. It is not necessary to obtain a referral number from the third-party administrator; however many specialists do require a referral or consultation request from the requesting provider. This does NOT eliminate the requirement for authorizations to be obtained for services and procedures that require a prior authorization. Information regarding these processes and forms are contained within the Utilization Management section of our provider manuals, listed above.
** Pursuant to § 383.14(1)(a) and 383.011(1)(e), F.S., this form must be completed by the health care provider for every pregnant woman and submitted to the local county health department.
*** Pursuant to § 383.14(1)(b) and 383.011(1)(e), F.S., this form must be completed for each infant and submitted to the local County Health Department, Office of Vital Statistics.
Provider Video: Finding the Florida Medicaid Fee Schedules and Handbooks
One of the most frequently asked questions at Ped-I-Care is, “Where do I find the Medicaid fee schedules and handbooks?” In this quick video, we’ll show you how to quickly, specifically navigate the AHCA website to find what you need.
Click here for the TRANSCRIPT – Where Do I Find the Florida Medicaid Handbooks and Fee Schedules.
Provider Video: Providing Services and Requesting Authorizations
This Ped-I-Care produced video covers the basics of requesting authorizations and using resources to ensure efficient processing of the authorization.
Click here for the TRANSCRIPT – Providing Services and Getting Paid.
Provider Video: Staying Compliant
This video is designed to help providers understand how to avoid common mistakes in billing and documentation. A guide to resources is also available.
Click here for the TRANSCRIPT – Staying Compliant.
Click here for the TRANSCRIPT – Preventing Claims Denials.